Heart failure (HF) is a severe clinical syndrome associated with signifi cant morbidity and mortality. According to the mechanisms of HF development, it is divided into two main clinical forms: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). While eff ective and specifi c treatment methods have been developed for HFrEF, leading to a decrease in the prevalence of this form of HF in recent years, the prognosis for patients with HFpEF remains unfavourable, and eff ective treatment methods do not yet exist. Therefore, the identifi cation of new molecular targets and therapeutic approaches is considered an important task of modern medicine. Data obtained in this fi eld have revealed the key involvement of epigenetic signals in the regulation of transcriptional programs underlying the development of HFpEF, which has contributed to the development of selective epigenetic drugs capable of reversing transcriptional changes and thus delaying or preventing the progression of HFpEF. Further thorough investigation of individual epigenetic landscapes may provide opportunities in the future for the development of personalized epigenetic biomarkers and treatment methods for HFpEF. The aim of this review is to consider the role of epigenetic processing, as well as its diagnostic and therapeutic possibilities in HFpEF.

The understanding of the tactics for managing patients with pulmonary hypertension (PH) of various etiologies is currently being developed. In August 2022, the European Society of Cardiology adopted new Guidelines for the management of patients with pulmonary hypertension. A separate cohort among them consists of patients with chronic thromboembolic pulmonary hypertension (CTEPH), classifi ed as Group 4 according to the WHO classifi cation. The possibilities of diagnosis, treatment methods, and their availability for this pathology have signifi cantly expanded over the past two decades. The aim of this study is to familiarize physicians with modern methods of treating CTEPH in order to timely refer patients to the most eff ective types of treatment currently available in expert centers in the Russian Federation. Materials and methods. The strategy for searching sources involved analyzing Medline (PubMed) and Scopus databases for the past 20 years using keywords such as diagnostic criteria for chronic thromboembolic pulmonary hypertension, treatment of chronic thromboembolic pulmonary hypertension. To search for additional materials on the topic, the lists of literature in relevant articles and reviews were analyzed.

The article is dedicated to the current problem of pyoseptic surgery, presenting an analytical review of the systematic literature that covers one of the rare forms of necrotizing fasciitis — Fournier’s gangrene. From the perspective of an evolutionary approach, the historical milestones in the formation of scientifi c views on the essence and etiopathogenesis of the disease, its epidemiology, classifi cation, clinical presentation, diagnosis, and treatment are presented. In the context of the defi nition, it is declared that in the modern understanding, “Fournier’s gangrene” implies a particular (specifi c) model of critical conditions in surgery, which is characterized by progressive purulent-necrotic lesions and putrefactive decomposition of fascial and soft tissue structures of the external genitalia, manifesting with systemic endotoxemia, septic shock, and high mortality rates. It is postulated that the intravascular invasion of causative microfl ora is at the basis of the pathogenetic mechanism of Fournier’s gangrene development, resulting in disseminated thrombosis of the microcirculatory bed of the superfi cial fascia of the scrotum. In accordance with the principles of evidence-based medicine, modern methods of diagnosis and treatment are outlined. It is shown that urgent surgical intervention in the format of “aggressive surgery,” with the main component being “manual elimination” of necrotic and non-viable tissues achieved through programmed (staged) sanitation necrectomy, is a priority in the treatment of patients with Fournier’s gangrene. Issues of adjuvant therapy using methods such as laser sanitation, vacuum wound therapy, and hyperbaric oxygenation are discussed. Based on a multifactorial analysis of data from contemporary literature, it is declared that a crucial condition that signifi cantly infl uences treatment outcomes and disease prognosis is a multidisciplinary approach to solving diagnostic and therapeutic tasks involving doctors from related specialties (surgeons, coloproctologists, urologists, dermatologists, intensivists, radiologists, bacteriologists).

The aim of the study was to compare the quality of life in patients after treatment of deep vein thrombosis with regional catheter thrombolysis using alteplase and urokinase, and to compare the results with clinical examination data. Material and methods. The assessment of quality of life and data from a control objective examination were conducted in 32 patients with deep vein thrombosis, divided into two statistically homogeneous groups of 16 individuals each. Alteplase was used for thrombolysis in the fi rst group, while urokinase was used in the second group. The quality of life in patients was evaluated using two questionnaires: SF-36 and CIVIQ-20. The severity of venous disease was determined based on the clinical assessment of venous return impairment. Results. In the fi rst group, the physical component of health according to the SF-36 questionnaire was 56 (49.5; 56.3), the psychological component was 54 (50; 68.8), while in the second group it was 34 (33; 34) and 38 (31.3; 45) respectively. The overall health assessment according to the CIVIQ-20 questionnaire was 20 (10.8; 30) in the fi rst group and 40 (32.8; 43.8) in the second group. In the clinical examination, venous return impairment was absent or mild in 75% of patients in the fi rst group, and equally distributed between mild and severe in 50% of patients in the second group. Conclusion. Alteplase thrombolysis has a more positive impact on the quality of life in patients compared to urokinase.

Diseases associated with atherosclerosis occupy a leading place among the causes of death in most countries of the world. Antiplatelet therapy is one of the most eff ective and promising methods of stroke prevention. Long-term use of platelet antiplatelet agents of various pharmaceutical groups in high-risk patients has become a daily clinical practice. As a result of the practical application of modern drug strategies, the life expectancy of stroke survivors is increasing. The average age of patients with cardiovascular pathology is increasing. The majority of patients receiving antiplatelet agents are over 70 years old. The number of patients continuously receiving antiplatelet agents for 10 years or more is already hundreds of thousands. In recent years, clinical guidelines have expanded the indications for the appointment of platelet antiplatelet agents of diff erent pharmaceutical groups. In neurology, clopidogrel, ticagrelor, cilostazol are allowed. However, the choice of the optimal treatment regimen in patients with cerebrovascular pathology often causes diffi culty for doctors. Standard treatment regimens for patients at high risk of stroke are based on the use of acetylsalicylic acid preparations. In some cases, patients receive a combination of antiplatelet agents: aspirin and dipyridamole. The author analyzes the results of 30 years of acetylsalicylic acid use in a patient with a high risk of thrombosis and bleeding. During this period, the patient suff ers a transient ischemic attack, ischemic stroke, hemorrhoidal bleeding and intracranial hemorrhage. The article discusses optimal solutions in choosing an antithrombotic strategy in patients with high risk of stroke on a clinical example. Based on the analysis of current clinical recommendations and scientifi c research, the article formulates the principles of long-term antiplatelet therapy for patients of older age groups with the need for long-term treatment. The main directions of diff erentiated antithrombotic therapy have been determined depending on the suspected pathogenetic subtype of ischemic stroke, the risk of bleeding, age and the expected duration of treatment.

If chronic heart failure (CHF) is accompanied by anemic syndrome and iron defi ciency (ID) tolerance to treatment develops, the eff ectiveness of drugs that form the basis of CHF treatment decreases, and the prognosis worsens. Aim. To evaluate the possibilities of using iron preparations with hepcidin-independent absorption mechanism depending on the characteristics of iron metabolism, erythropoiesis and the level of infl ammation in patients with CHF and anemia. Material and methods. The study included 68 patients diagnosed with CHF to describe the characteristics of anemia (General group). Further, 56 patients who signed consent to the study were divided into two groups: 30 patients (Treatment Group) with standard CHF therapy and iron preparations, and 26 (Comparison Group) with standard CHF therapy only. Sucrosomial iron (SI) was used 60 mg per day orally for three months. Results. Variants of anemia in CHF: absolute ID (AID) — 43%, functional ID (FID) — 19%, anemia without ID — 38%. In the treatment group, an increase in hemoglobin (Hb, p < 0.002), hematocrit (Ht, p < 0.001), mean corpuscular volume (MCV, p < 0.002) and serum ferritin (SF, p < 0.05), in the Сomparison group only Ht, p < 0.01, and the greatest increase in Hb was detected in patients with SF < 30 μmol/l (p < 0.002). Conclusion. Anemia in CHF corresponds to the signs of anemia of chronic disease (ACD) with J, while J was detected in 62% of patients. The use of SI signifi cantly increases erythrocyte counts and SF/

The level of mortality from ischemic heart disease (IHD) is infl uenced by a signifi cant number of factors. Objective. Assessment of the dynamics and variability of standardized mortality rates (SMR) from chronic IHD and acute forms of ischemic heart disease (AIHD) in the regions of the Russian Federation (RF) in 2013–2021. Material and methods. Data from Rosstat for 2013–2021 on the average annual population and number of deaths in one-year age groups in 82 regions of the RF based on the “Brief Nomenclature of Causes of Death of Rosstat” (BNCDR). SMRs were calculated based on the European standard per 100,000 population. Results. From 2013 to 2019, most regions showed an unstable trend towards a decrease in SMRs from chronic IHD, myocardial infarction (MI), and other AIHD (ICD codes — I20.0, I20.1–9), and an increase in SMRs in 2020 and 2021. The greatest decrease in SMRs was registered for other AIHD (40.2 ± 37.9 in 2013 and 20.5 ± 26.8 in 2021 per 100,000 of population). The coeffi cient of variation between regional SMRs for other AIHD was 120%, for MI — 45%, and for chronic IHD — 37%. Statistically signifi cant diff erences between 2021 and 2013 were found for SMRs from chronic IHD (225.3 ± 76.5 and 207.4 ± 76.9), other AIHD, but not for MI (38.2 ± 18.1 and 30.7 ± 14). Overall, the SMRs from all forms of IHD in 2021 exceeded the indicators of 2013 in 19 regions. The variability and dynamics of regional SMRs from diff erent forms of IHD may be due to both the possibilities and quality of preventive and therapeutic measures, as well as diff erent approaches to determining the cause of death. Conclusions. Most regions show unstable dynamics towards a decrease in SMRs from diff erent forms of IHD, and the obtained results require clarifi cation of the criteria for IHD as the underlying cause of death. 

The article discusses the controversial terminology of biliary refl ux gastritis and the factors predisposing to its occurrence. Pathogenesis of this disease includes 2 main components: disorders of motility of the stomach and duodenum, leading to duodeno-gastric refl ux, and direct damaging eff ect of hydrophobic bile acids and lysolecithin on the protective barrier of the stomach mucosa. Clinical picture of biliary refl ux gastritis is nonspecifi c and most often corresponds to dyspepsia syndrome. Esophagogastroduodenoscopy with biopsy and subsequent histological examination, 24-hour pH-metry of the stomach, monitoring of bilirubin level in gastric contents are used in diagnostics of this disease. Treatment of biliary refl ux gastritis includes prescription of ursodeoxycholic acid, prokinetics, antacids, proton pump inhibitors, cytoprotectors. Given the insuffi cient study and controversial coverage of many aspects of biliary refl ux gastritis, this problem requires further research.

In the departments of pediatric surgery in clinics in Ryazan and Zaporizhia, 5 girls aged 12–16 years with malformations of the urinary and genital system were observed: duplication of the vagina and uterus, aplasia of the duplicated vagina in combination with aplasia of the kidney on the side of the malformation. In 3 children, the combined defect was right-sided, in 2 — left-sided, and accompanied by hematocolpos and hematometra. In the diagnosis of malformations of the urinary and genital system in girls, anamnesis, examination of the abdominal cavity and bimanual examination, ultrasound examination, excretory urography, vaginoscopy, and computed tomography were used. Currently, surgical excision of the underdeveloped vaginal wall is performed to empty it from menstrual discharge. The imposition of a wide window in the septum between the aplastic and healthy vagina is the preferred operation. Further observations are carried out by gynecologists.

Ectopic varices are any pathologically dilated collaterals in diff erent areas of the gastrointestinal tract, developing as a result of portal hypertension. When localized in the digestive system, varicose veins can be the cause of approximately 5% of cases of bleeding, with a high (up to 40%) fatality rate due to the diffi culty in diagnosing and treating them. The aim of this study is to present a rare clinical observation of recurrent gastrointestinal bleeding from varicose veins of the small intestine. Materials and methods: this article presents a clinical case of recurrent bleeding from ectopic varicose veins of the small intestine in a 65-year-old female patient. The patient was admitted to our hospital with complaints of tarry stools and weakness. She had undergone esophagogastroduodenoscopy (EGD) and colonoscopy (CS) at her place of residence, but no pathology was detected. She was referred to the surgical department of the State Budgetary Healthcare Institution “City Clinical Hospital No. 2” to determine the treatment strategy. In the conditions of the City Clinical Hospital No. 2 in Krasnodar, comprehensive endoscopic diagnostics of the digestive system were performed on the patient, including EGD, CS, video capsule endoscopy (VCE), and balloon-assisted enteroscopy (BAE). Results: erosions of the prepyloric part of the stomach were detected during EGD. Data indicating bleeding from the upper parts of the digestive system were found during colonoscopy. After appropriate preparation, video capsule endoscopy (VCE) was performed on the patient, which revealed signs of ongoing bleeding. Balloonassisted enteroscopy (BAE) was performed on the patient under endotracheal anesthesia in the operating room. Multiple bluish varicose veins, protruding into the lumen up to a distance of 4–5 mm, were visualized throughout the examined length of the small intestine (80 cm from the Treitz ligament). The patient underwent surgical intervention — resection of the aff ected segment of the small intestine. Conclusions: the presented modern methods of small bowel examination — capsule endoscopy and balloon-assisted enteroscopy — provide the opportunity for highly informative endoscopic examination, which signifi cantly aff ects the timeliness of diagnosis and early detection of small bowel diseases.

The data on the warfare of the Russian Expeditionary Force and the Honorary Russian Legion in France during the First World War are presented. A study of the biographical data of the military doctors of the Force was carried out, and their fates were traced in some cases. Information is given about the hospitals and infi rmaries of the Russian Red Cross Society, their work in France. The facts about the sisters of mercy of the RRCS are also provided.

The article presents the life and creative path of a prominent Russian surgeon, a talented organizer of military fi eld surgery, a well-known public figure, an excellent clinician, a wonderful teacher, Honored Scientist of the RSFSR, professor, Major General of the medical service Vladimir Semyonovich Levit.

Тhe article presents brief characteristics of military fi eld surgeons — representatives of the S.P. Fedorov school, who during the Great Patriotic War were chief surgeons of the fronts and fleets